Provider Demographics
NPI:1609886902
Name:PELIMSKAYA, LUTSIYA S (MD)
Entity Type:Individual
Prefix:
First Name:LUTSIYA
Middle Name:S
Last Name:PELIMSKAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 ROUTE 130 STE 120
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1869
Mailing Address - Country:US
Mailing Address - Phone:856-764-1840
Mailing Address - Fax:856-764-7997
Practice Address - Street 1:8008 ROUTE 130 STE 120
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-1869
Practice Address - Country:US
Practice Address - Phone:856-764-1840
Practice Address - Fax:856-764-7997
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07628200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH99123Medicare UPIN
NJ075795PE1Medicare ID - Type Unspecified